NYAPRS Note: Clinicians and policymakers alike have often expressed reluctance in a telepsychiatry approach, perceiving it as a simplified method to replace an intensive interaction that may be needed in a therapeutic relationship. But evidence from the Veteran’s health community indicates that telepsychiatry can yield tremendous benefits, particularly when a geographic range or economic issues make travelling to appointments difficult. Telepsychiatry can increase consumer access, diminish numbers of missed appointments, and offer opportunities for team approaches to therapeutic interventions. The approach is also noted as a groundbreaking way to address the health and cultural needs of youth and their families. Below, the NYS OMH Director of the Bureau of Inspection and Certification Keith McCarthy offers guidance and resources to help clinicians become familiar with the new regulations and successfully implement the approach.
Telepsychiatry Regulation
OMH News; Keith McCarthy, 3/9/2015
Effective February 11, 2015, OMH established the basic standards and parameters for use of “telepsychiatry” in OMH-licensed clinic programs. Adopted as a new Section 599.17 to 14 NYCRR Part 599, “Clinic Treatment Services”, this new regulation allows telepsychiatry to be utilized for assessment and treatment services provided by physicians or psychiatric nurse practitioners, from a site distant from the location of a recipient, where both the patient and the physician or nurse practitioner are physically located at clinic sites licensed by OMH.
“Telepsychiatry” is defined as the use of two-way real time-interactive audio and video equipment to provide and support clinical psychiatric care at a distance. Such services do not include a telephone conversation, electronic mail message or facsimile transmission between a clinic and a recipient, or a consultation between two professional or clinical staff.
In addition to the regulation, OMH has published an implementation document to provide guidance to New York State providers that are currently licensed by OMH to perform clinic treatment services, and who wish to offer telepsychiatry to the persons they serve. This document describes the implications for OMH operating certificates (i.e., how to add telepsychiatry as an optional service, as well as the inspection process), clinical guidance, training resources, billing guidelines, and technology and telecommunication standards.
While telepsychiatry creates opportunities for increased access to psychiatrists and psychiatric nurse practitioners, legitimate concerns exist about privacy, security, patient safety, and interoperability. To address potential obstacles and to improve the quality of care, national organizations have developed practice guidelines and practice parameters. OMH advises clinics seeking approval to utilize telepsychiatry services to review these guidelines and incorporate relevant provisions in their plans, consistent with their target population.
Prior to initiating telepsychiatry services, policies and procedures at both the originating site and the distant site should be in place that address the following topics:
• General Clinic Procedures
• Physical Environment
• Site and Check-in Prodedures
• Emergency Procedures
• Patient Enrollment for Telepsychiatry and Informed Consent
• Collaborating with patient’s interdisciplinary treatment team
• Care between telepsychiatry sessions
• Prescriptions, labs and orders
• Confidentiality and privacy of health information
• Quality Review
OMH is excited about the potential for telepsychiatry to provide increased access to mental health services, particularly in rural and remote regions of the State, and to enhance the provision of services to adults, children and families.
http://omh.ny.gov/omhweb/resources/newsltr/2015/february/february-omh-newsletter.pdf